Background : Hepatocellular carcinoma (HCC) is a formidable challenge in clinical oncology, particularly when it presents as a huge tumor (>10cm). The optimal treatment strategy for these cases remains debated. This nationwide study aims to compare the outcomes of liver resection (LR) and trans-arterial chemoembolization (TACE) in patients with huge HCC (>10cm), utilizing a propensity score-adjusted analysis to minimize selection bias.

Methods : A comprehensive analysis of a nationwide database was conducted, identifying patients with HCC tumors exceeding 10cm in size who underwent either LR or TACE between 2013 and 2019. Propensity score matching was employed to create balanced cohorts for comparative analysis. Primary outcomes included overall survival (OS) and disease-free survival (DFS).

Results : A total of 9281 patients with huge HCC were included in this study, with 1468 patients in each treatment group after propensity score matching. LR was associated with a significantly superior OS compared to TACE (hazard ratio 2.78, 95% CI 2.50-3.10, P<0.001)

Conclusions : In patients with huge HCC, LR appears to offer superior OS compared to TACE, according to this nationwide propensity score-adjusted analysis. These findings suggest that LR should be considered as the primary treatment option for eligible patients with huge HCC, emphasizing the importance of early diagnosis and timely intervention. Further research, including prospective trials, is warranted to validate these results and refine treatment recommendations.